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MISSISSAUGA, Ontario — Community pharmacy in Canada is grappling with a new reality as payers strive to limit drug expenditures and other health care costs while opportunities open up for pharmacists to deliver new, remunerated services.
The Pharmacy Forum that the Canadian Foundation for Pharmacy organized November 23 and November 24 here aimed to provide both context for and commentary on the challenges the sector faces.
So far, the income derived from the new services falls well short of the revenue loss resulting from drug payment reforms. There was, however, broad consensus among the speakers at the forum that the successful shift to a new business model will depend not only on the actions of governments and regulators in sanctioning the new services and establishing appropriate remuneration for them but also on the willingness of pharmacy owners and their professional staff to be proactive in applying their new powers.
In a set of presentations on November 23 three speakers set the scene for the presentations and discussions the following day.
Ross Tsuyuki, professor and director of Epicore Centre, Faculty of Medicine and Dentistry at the University of Alberta, described the Blueprint for Pharmacy as a powerful vision for the future of pharmacy practice in Canada. However, it is clear, Tsuyuki said, that pharmacists will have to overcome some barriers of their own making if they are to fulfill the expectations of the Blueprint.
Tsuyuki cited a survey of 101 community pharmacists from across the Edmonton area who were asked by a researcher to categorize the priorities of their profession. Only 40% described their mission as being patient-centred; 33% gave highest priority to drug distribution; 17% of responses were described as ambiguous. Research and business were each cited by small percentages of respondents as ranking highest in their minds.
“Culture eats strategy for breakfast,” said Tsuyuki, when it comes to pharmacy pressing its case for greater responsibility in the health care world. He suggested at least part of the blame could be ascribed to personality traits: passivity, lack of confidence, fear of new responsibilities, risk aversion, paralysis in the face of ambiguity, and need for approval, which commonly afflicts members of the profession.
Yet, Tsuyuki posited, the case for a proactive role for community pharmacy is strong. He cited a study in which the experience of a group of patients suffering from diabetes and high blood pressure received interdisciplinary monitoring and care coordinated through a community pharmacy. Over a six-month period the patients experienced reductions in blood pressure that, when extrapolated, would have implied a reduction of 30% in heart attacks, 23% in CHD incidents and 13% in deaths.
Tsuyuki also referred to the preliminary results of an ongoing study of the readings of patients using a blood pressure kiosk in a retail pharmacy. It was clear that if all the patients showing elevated readings could have been diverted to counselling with a pharmacist, and thus to interdisciplinary care, there would have been a significant improvement in the patients’ health and substantially increased business for the pharmacy.
Dr. Dorian Lo, executive vice-president of pharmacy and health care at Shoppers Drug Mart, drew on his recent experience in the U.S. health care system to suggest that the most effective way to achieve change was through using appropriate incentives. It was through the monetary incentives offered by private payers in the United States that high rates of generic penetration and the substantial use of mail order were achieved. Appropriate monetary incentives were likely the key to pharmacists’ exercising the new powers they were being accorded.
David Caplan, former Ontario minister of health and long-term care, reminded his audience of the factors that had moved the department, when he was its minister in the mid-1990s, to start the process of reform of the basis of remuneration for pharmacists. Drug costs were escalating at rates far in excess of other components of the health care system, and Ontarians were paying more for generics than the public in other jurisdictions.
“Change is a process, not an event,” Caplan pointed out, and he assured his listeners that many more health reforms lie ahead. The demographics mean that the current system is unsustainable. In 15 years 14% of the population, some 6 million people, will be over 65.
Canadians highly value their current system, but the way health care is delivered will continue to change. Pharmacists will play a crucial role in the system though their duties and the basis of their remuneration will inevitably change.
